Case oneI was asked to examine the anterior segment of a woman in her 70s with
a slit-lamp. She had had a right trabeculectomy and advanced cupping in
this eye. There were no signs of pseudoexfoliation syndrome or other secondary
changes. I diagnosed primary open angle glaucoma.
I was grilled on the different types of anti-glaucoma treatment and
their side-effects.

Case twoAgain a slit-lamp examination. The patient had a left lamellar keratoplasty.
There was no other signs to suggest the reason for the graft.
I was asked about the post-operative management of corneal graft and
the advantages and disadvantages of lamellar vs penetrating keratoplasty.

Case threeFundal examination using a 90D lens. The patient had a greyish lesion
which is slightly elevated located in the periphery of the left posterior
segment. Questions on the differential diagnosis and treatment options
for choroidal melanoma

Case fourThis is again a slit-lamp examination. The patient had a right iridodialysis
and stallate cataract. I made a diagnosis of blunt ocular trauma. I asked
to examine the posterior segment for choroidal rupture and possible retinal
changes from detachment surgery. However, there were no such changes when
I examined the fundi with a 90D lens.
One of the examiners asked me about the management of traumatic hyphaema
and the possible causes of raised intraocular pressures following blunt
trauma.

Medical Ophthalmology

Case oneI was asked to examine the anterior segment of a young girl with thick
plus lenses. I found bilateral aphakia and told the examiner that I suspected
that she may have Marfan's syndrome.
I was asked about the characteristic features of Marfan's syndrome
which this patient had in abundance (long fingers, high arch palate, arm
span longer than height.) I was asked to listen to her chest and she had
signs of diastolic murmur and I gave a differential diagnosis of aortic
valve incompetence and aortic root dilatation. I was asked what medication
I would prescribe the patient and I suggested beta-blockers and the examiners
seemed satisfied with the answer.

Case twoThe patient was a young woman with a dilated left pupil and I was asked
to perform pupillary examination.
There was light-near dissociation. I diagnosed Adie's pupil and told
the examiner that I would also like to examine the left iris on the slit-lamp
for vermiform movement and also test the patient's tendon reflexes for
signs of Holme-Adie's syndrome.
The examiners then asked about the differential diagnosis of light-near
dissociation. Most of the questions centred on Argyll-Robertson's pupils
and the site of the lesion. Then I was asked how syphilis can affect the
eye.

Case threeI was asked to examine the hands of a patient who had symmetrical joint
deformities characteristic of rheumatoid arthritis. I was asked about the
ocular signs which may occur in rheumatoid arthritis.
I was then asked to examine the upper lids of the same patient. He
had bilateral ptosis which appeared to be variable but prolonged upgaze
caused the ptosis to increase. I diagnosed myasthenia gravis. The examiner
wanted to know if I could link the rheumatoid arthritis to the ptosis.
I mentioned penicillamine (penicillamine can cause drug-induced myasthenia
gravis). The examiners appeared surprised that I could produce the right
answer so quickly.

Case fourVisual field examination of a middle-aged man. He had a left congruous
homonymous hemianopia. There were no other neurological deficits. I mentioned
that the lesion is probably at the occipital lobe.
The examiners wanted to know how I would investigate the patient. I
mentioned physical examination for possible sources of emboli (arrhthymia,
valvular diseases, carotid stenosis) and measure the blood pressure for
hypertension.

Case fiveAfter case four, the examination became mainly an oral examination.
The two main questions were:
a. What points would I include if I have to give a lecture to a group
of casualty doctors on eye signs which may be potentially life-threatening?
(third nerve palsy, papilloedema, bilateral subconjunctival haemorrhage
from basal skull injury etc)
b. A patient developed shortness of breath 24 hours after a prolonged
vitreoretinal surgery. What is my differential diagnosis? (The question
revolved mainly on pulmonary embolism).